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1.
Arch Gen Psychiatry ; 39(1): 77-81, 1982 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-6798950

RESUMO

To explore the possible utility of the protirelin test in differentiating manic and schizophrenic patients, we gave a test dose of protirelin to 30 consecutive euthyroid inpatients who met Research Diagnostic Criteria for mania, 30 who met criteria for schizophrenia, undifferentiated subtype, and 20 normal volunteer controls. The mean maximal thyroid-stimulating hormone (TSH) response (delta TSH) to protirelin in the manic patients was lower than in the schizophrenic patients and in the controls. This mean difference was not attributable to differences in age, sex, baseline thyroid functioning, cortisol levels, or medication, but there was a considerable overlap of values in the patient groups. However, with a delta TSH less than or equal to 7.0 I microunits/mL to identify manic patients in the overall group, the sensitivity of the protirelin test was 60% and the specificity was 84%.


Assuntos
Transtornos Psicóticos Afetivos/diagnóstico , Transtorno Bipolar/diagnóstico , Esquizofrenia/diagnóstico , Hormônio Liberador de Tireotropina , Adulto , Transtorno Bipolar/sangue , Feminino , Humanos , Masculino , Esquizofrenia/sangue , Tireotropina/sangue , Tiroxina/sangue , Tri-Iodotironina/sangue
2.
Biol Psychiatry ; 16(9): 819-24, 1981 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-6794655

RESUMO

Change in maximal TSH response to a TRH infusion were measured in 18 unipolar depressed males and 2 control groups matched for age, sex, and base-line thyroid status. The mean maximal change in TSH response was significantly lower for the unipolar than the control groups. Clinical and research implications of these findings are discussed. By using a deltaTSH cutoff of 7.0 rather than 5 microIU/ml, 14 rather than 7 depressed patients were correctly identified as having a blunted deltaTSH; 29 rather than 32 to 36 control patients were correctly identified as having a normal deltaTSH score.


Assuntos
Transtorno Depressivo/diagnóstico , Hormônio Liberador de Tireotropina , Tireotropina/sangue , Adulto , Transtorno Depressivo/sangue , Diagnóstico Diferencial , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos da Personalidade/sangue , Radioimunoensaio , Esquizofrenia/sangue
3.
Am J Psychiatry ; 139(9): 1196-8, 1982 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-6287871

RESUMO

The authors present a case report of the presence of urinary cannabinoids during 21 days of supervised abstinence from chronic marijuana use and provide data on 6 similar cases. They discuss the theoretical implications of the persistence of cannabinoids.


Assuntos
Canabinoides/urina , Abuso de Maconha/urina , Adulto , Dronabinol/urina , Humanos , Masculino , Abuso de Maconha/reabilitação , Fatores de Tempo
5.
Am J Psychiatry ; 142(9): 1097-9, 1985 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-3927753

RESUMO

The authors administered the thyrotropin-releasing hormone (TRH) test to 17 patients with severe cocaine abuse and without major depression. The results suggest that the test is not specific for major depression when serious cocaine abuse is present.


Assuntos
Cocaína , Transtorno Depressivo/diagnóstico , Transtornos Relacionados ao Uso de Substâncias/complicações , Hormônio Liberador de Tireotropina , Adulto , Transtorno Depressivo/sangue , Transtorno Depressivo/complicações , Estudos de Avaliação como Assunto , Feminino , Humanos , Masculino , Tireotropina/sangue
6.
Am J Psychiatry ; 140(7): 909-10, 1983 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-6859312

RESUMO

Dexamethasone suppression test sensitivity in 188 patients was 61.6% when cortisol was measured at six time points and 48.5% when cortisol was measured twice. More patients had abnormal cortisol levels at 8:00 p.m. than at 4:00 p.m. or 10:00 p.m.


Assuntos
Transtorno Depressivo/diagnóstico , Dexametasona , Hidrocortisona/sangue , Transtorno Depressivo/sangue , Hospitalização , Humanos , Periodicidade
7.
Am J Psychiatry ; 141(5): 698-700, 1984 May.
Artigo em Inglês | MEDLINE | ID: mdl-6711695

RESUMO

Among 50 inpatients, the sensitivity and specificity of the dexamethasone suppression test (DST) were 51.7% and 85.7%, respectively. For the cortisol suppression index they were 10.3% and 91% at 8:00 a.m. and 51.7% and 57.1% at 4:00 p.m. Thus, the cortisol suppression index does not appear to be an adequate substitute for the DST.


Assuntos
Dexametasona , Hidrocortisona/sangue , Transtornos Mentais/sangue , Adolescente , Adulto , Idoso , Transtorno Depressivo/sangue , Transtorno Depressivo/diagnóstico , Estudos de Avaliação como Assunto , Feminino , Hospitalização , Humanos , Masculino , Transtornos Mentais/diagnóstico , Pessoa de Meia-Idade
8.
Am J Psychiatry ; 141(5): 680-3, 1984 May.
Artigo em Inglês | MEDLINE | ID: mdl-6424482

RESUMO

The authors examined dexamethasone suppression test (DST) and thyrotropin-releasing hormone (TRH) test results in 32 chronic alcoholics without depression or hepatic disease to see if alcoholism alone might lead to positive test results. After 3 weeks of sobriety there were no DST abnormalities, but blunted TRH test results were observed in eight of the 32 alcoholics. More of the 15 patients also tested during alcohol withdrawal than of the 20 normal subjects or the 32 alcoholics without alcohol withdrawal had DST and TRH test abnormalities. When performed after 3 weeks of sobriety, the DST but not the TRH test has potential as a specific laboratory adjunct in the diagnosis of depression in alcoholics.


Assuntos
Alcoolismo/sangue , Transtorno Depressivo/sangue , Dexametasona , Hormônio Liberador de Tireotropina , Adulto , Alcoolismo/complicações , Alcoolismo/diagnóstico , Transtorno Depressivo/diagnóstico , Transtorno Depressivo/etiologia , Etanol/efeitos adversos , Feminino , Humanos , Hidrocortisona/sangue , Masculino , Pessoa de Meia-Idade , Síndrome de Abstinência a Substâncias/sangue , Síndrome de Abstinência a Substâncias/diagnóstico , Síndrome de Abstinência a Substâncias/etiologia , Tireotropina/sangue , Tiroxina/sangue
9.
Psychoneuroendocrinology ; 10(3): 281-8, 1985.
Artigo em Inglês | MEDLINE | ID: mdl-4059475

RESUMO

Failure to suppress cortisol secretion after administration of dexamethasone has been reported to be a diagnostic marker for major depression and to have prognostic implications when repeated after antidepressant treatment. The pulsatile pattern of cortisol secretion suggested to us that increasing the number of post-dexamethasone cortisol determinations might significantly increase the sensitivity of the dexamethasone suppression test (DST) for major depression. With a conventional two-point DST (1600 h and midnight), 5% of 20 normal volunteers, 8% of 13 inpatients with non-major depressions, and 31% of 65 inpatients with primary major depression failed to suppress. With six post-dexamethasone points (0800 h, 1200 h, 1600 h, 2000 h, 2200 h, midnight), the respective percentages were 10, 15 and 44%. The additional points increased the sensitivity from 31 to 44%, mostly by identifying more major depressives with a "late escape" pattern. If a clinician is using the DST to establish a marker for major depression that can be repeated to monitor response to treatment and the likelihood of relapse, then perhaps the increased sensitivity of the six-point DST would be helpful, despite a modest decrease in specificity from 94 to 88%.


Assuntos
Transtorno Bipolar/fisiopatologia , Transtorno Depressivo/fisiopatologia , Dexametasona , Hidrocortisona/sangue , Transtornos de Adaptação/fisiopatologia , Adulto , Depressão/fisiopatologia , Feminino , Humanos , Sistema Hipotálamo-Hipofisário/fisiopatologia , Masculino , Sistema Hipófise-Suprarrenal/fisiopatologia , Fatores de Tempo
10.
Psychoneuroendocrinology ; 8(4): 459-62, 1983.
Artigo em Inglês | MEDLINE | ID: mdl-6425891

RESUMO

Borderline patients can be both a diagnostic and a therapeutic enigma. We investigated a group of 24 depressed women with borderline personality disorder or strong borderline features by DSM III criteria for the presence of either an abnormal dexamethasone suppression test (DST) or a blunted TSH response to TRH, abnormalities which have been reported in major depression. Thirteen of the 24 borderlines failed to suppress on the DST, compared with one of 14 normal women (p less than 0.01). Nine of the 24 borderlines had a blunted TSH response to TRH, compared with one of 11 normal women. Neuroendocrine abnormalities were found in a total of 75% of the borderline women, independent of whether or not they met DSM III criteria for major depressive disorder. The results of this study support the notion that many borderline patients with depression have a genuine affective component to their illness, perhaps biologically similar to major depression in non-borderlines.


Assuntos
Transtorno da Personalidade Borderline/diagnóstico , Transtorno Depressivo/diagnóstico , Dexametasona , Transtornos da Personalidade/diagnóstico , Hormônio Liberador de Tireotropina , Adolescente , Adulto , Transtorno da Personalidade Borderline/sangue , Ritmo Circadiano , Transtorno Depressivo/sangue , Feminino , Humanos , Hidrocortisona/sangue , Pessoa de Meia-Idade , Tireotropina/sangue
11.
J Clin Psychiatry ; 43(7): 290-1, 1982 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-6806254

RESUMO

A 24-year-old woman with a unipolar depression had an augmented thyroid-stimulating hormone response to thyrotropin-releasing hormone (TRH), suggesting subclinical hypothyroidism. Desipramine produced rapid cycling between depression and hypomania. After discontinuation of the desipramine she was successfully treated with lithium and thyroid hormone replacement. We discuss the possible role of hypothyroidism in the etiology of tricyclic-induced rapid mood cycling, and suggest that the TRH test may help identify depressed patients predisposed to rapid mood cycling on tricyclics. The possibility that such patients respond to lithium and/or thyroid hormone replacement needs to be further investigated.


Assuntos
Transtorno Bipolar/induzido quimicamente , Transtorno Depressivo/tratamento farmacológico , Desipramina/efeitos adversos , Hipotireoidismo/complicações , Adulto , Transtorno Bipolar/tratamento farmacológico , Transtorno Bipolar/psicologia , Transtorno Depressivo/complicações , Transtorno Depressivo/psicologia , Feminino , Humanos , Hipotireoidismo/diagnóstico , Hipotireoidismo/tratamento farmacológico , Lítio/uso terapêutico , Carbonato de Lítio , Hormônio Liberador de Tireotropina , Tiroxina/uso terapêutico
12.
J Clin Psychiatry ; 43(6 Pt 2): 35-8, 1982 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-7085583

RESUMO

We have studied and reviewed data reported by others, which support a norepinephrine (NE) hyperactivity hypothesis for opiate withdrawal. Other hypotheses explained parts of the opiate withdrawal syndrome but the NE hypothesis had the potential to explain most of the clinical manifestations of abrupt opiate discontinuation in addicted persons. Clonidine's ability to almost completely reverse the opiate withdrawal syndrome in acute withdrawal studies supported the NE hypothesis and suggested a new use of clonidine. Lofexidine's efficacy was additional support for the NE hypothesis. Clonidine is an effective emergency treatment for acute opiate withdrawal and in the detoxification of methadone, heroin, and other opiate addictions. Clonidine reverses the cognitive, affective, and physiological signs and symptoms and continues to suppress their re-emergence when given for 10-14 days in a detoxification protocol. NE hyperactivity in withdrawal may result from endorphin system dysfunction at the level of the locus coeruleus (LC), the mismatch between needed NE, opiate and other inhibition at the LC in the person addicted to high doses of powerful exogenous opiate LC inhibitors and available endogenous inhibitory substances or other mechanisms.


Assuntos
Clonidina/uso terapêutico , Transtornos Relacionados ao Uso de Opioides/reabilitação , Síndrome de Abstinência a Substâncias/reabilitação , Animais , Relação Dose-Resposta a Droga , Endorfinas/metabolismo , Humanos , Locus Cerúleo/metabolismo , Inibição Neural/efeitos dos fármacos , Norepinefrina/metabolismo , Transtornos Relacionados ao Uso de Opioides/metabolismo , Ratos , Síndrome de Abstinência a Substâncias/metabolismo
13.
J Clin Psychiatry ; 48(2): 47-50, 1987 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-3468103

RESUMO

A structured clinical interview designed to diagnose eating disorders was administered to 259 consecutive callers to the National Cocaine Hotline who met DSM-III criteria for cocaine abuse. Thirty-two percent of those surveyed met DSM-III criteria for either anorexia nervosa, bulimia, or both disorders. The prevalence rates for each of these disorders in this sample appeared elevated even when narrow diagnostic criteria were applied. The data suggest that drug abusers should be screened carefully for the presence of an eating disorder and that abnormalities of eating behaviors seen among these individuals should not be attributed simply to drug use.


Assuntos
Cocaína , Transtornos da Alimentação e da Ingestão de Alimentos/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/complicações , Adolescente , Adulto , Anorexia Nervosa/diagnóstico , Anorexia Nervosa/epidemiologia , Bulimia/diagnóstico , Bulimia/epidemiologia , Transtornos da Alimentação e da Ingestão de Alimentos/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos
14.
J Clin Psychiatry ; 43(5): 191-4, 1982 May.
Artigo em Inglês | MEDLINE | ID: mdl-6804446

RESUMO

Relationships between clinical measures, diagnosis and neuroendocrine findings were examined in a group of 25 primary depressives maintained drug free on a Neuropsychiatric Evaluation Unit. The TSH response to TRH infusion curves for unipolar and bipolar depressives were significantly different. Agitated patients but not psychomotor retarded patients demonstrated a blunted TSH response curve. No relationships were noted for cortisol hypersecretion and/or loss of diurnality and either diagnosis or psychomotor activity levels in depression. Biochemical and diagnostic implications of these findings are discussed.


Assuntos
Transtorno Depressivo/diagnóstico , Hormônio Liberador de Tireotropina , Adulto , Idoso , Transtorno Bipolar/sangue , Transtorno Bipolar/diagnóstico , Transtorno Depressivo/sangue , Diagnóstico Diferencial , Humanos , Hidrocortisona/sangue , Pessoa de Meia-Idade , Tireotropina/sangue
15.
Psychiatr Clin North Am ; 7(3): 503-17, 1984 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-6148743

RESUMO

The authors emphasize the favorable response of most patients with major depression to appropriate pharmacotherapy, and present a decision-tree approach to the pharmacotherapy of major depression. Also discussed are use of contemporary clinical nosology and neuroendocrine diagnostic tests to identify candidates for pharmacotherapy and/or ECT, use of secondary tricyclics because of their lower incidence of side-effects, monitoring plasma levels of antidepressants to achieve therapeutic levels, and potentiating tricyclic nonresponders with T3 or lithium.


Assuntos
Antidepressivos/uso terapêutico , Transtorno Depressivo/tratamento farmacológico , Transtornos Psicóticos Afetivos/tratamento farmacológico , Antidepressivos Tricíclicos/efeitos adversos , Antidepressivos Tricíclicos/sangue , Antipsicóticos/uso terapêutico , Transtorno Bipolar/tratamento farmacológico , Transtorno Depressivo/diagnóstico , Desipramina/uso terapêutico , Dexametasona , Relação Dose-Resposta a Droga , Sinergismo Farmacológico , Eletroconvulsoterapia , Humanos , Cinética , Lítio/uso terapêutico , Inibidores da Monoaminoxidase/sangue , Nortriptilina/uso terapêutico , Tri-Iodotironina/uso terapêutico
16.
Drug Alcohol Depend ; 6(4): 201-8, 1980 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-7023893

RESUMO

In a placebo-controlled, double-blind crossover trial, clonidine caused a marked and significant reduction of objective signs and subjective symptoms of opiate withdrawal in thirty hospitalized opiate addicts. In an open trial of clonidine in opiate withdrawal, clonidine was found to suppress opiate withdrawal signs and symptoms, allowing all of the patients to detoxify successfully from chronic opiate addiction. Clonidine was demonstrated to reverse and suppress the signs, symptoms, and effects associated with opiate withdrawal. These data support a release from chronic opiate-induced noradrenergic inhibition producing noradrenergic hyperactivity as the pathophysiological substrate for opiate withdrawal. Clonidine replaces opiate-mediated inhibition with alpha-2 mediated inhibition of noradrenergic nuclei.


Assuntos
Clonidina/uso terapêutico , Entorpecentes/efeitos adversos , Síndrome de Abstinência a Substâncias/tratamento farmacológico , Encéfalo/efeitos dos fármacos , Ensaios Clínicos como Assunto , Clonidina/administração & dosagem , Clonidina/farmacologia , Método Duplo-Cego , Humanos
17.
Drug Alcohol Depend ; 8(3): 257-62, 1981 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-6276118

RESUMO

Chronic exogenous opiate administration might be responsible for the acute and protracted abstinence syndrome by producing a prolonged decrease in the availability of endogenous opioids (endorphins). However, the hypothesis that potent exogenous opiates may have anti-endorphin effects has been difficult to test. We have been investigating this hypothesis with neuroendocrine test paradigms which have provided preliminary evidence of anti-endorphin effects for chronic methadone. Naloxone-induced ACTH response data from chronic methadone addicts offers preliminary support for the hypothesis that chronic exogenous opiate administration has anti-endorphin effects. The subjects were 7 male methadone addicts who had been addicted to greater than or equal to 40 mg of methadone and 7 male healthy opiate-naive volunteers. Naloxone failed to produce a significant increase in ACTH in methadone addicts while opiate-naive normal volunteers demonstrated a significant naloxone-induced release of ACTH. Five of the seven methadone addicts ahd no demonstrable ACTH response to naloxone. These impaired naloxone response data reported here for recently detoxified addicts suggest that chronic methadone administration comprises the functional integrity of the endorphin system. Prolonged abstinence, post-detoxification depression and other affective symptoms which contribute to relapse may result from a prolonged endorphin derangement.


Assuntos
Hormônio Adrenocorticotrópico/metabolismo , Endorfinas/fisiologia , Metadona/efeitos adversos , Naloxona/farmacologia , Transtornos Relacionados ao Uso de Opioides/fisiopatologia , Humanos , Masculino , Síndrome de Abstinência a Substâncias/etiologia
18.
J Affect Disord ; 5(3): 233-7, 1983 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-6224835

RESUMO

Twenty-five men and 26 women with major unipolar depression were evaluated by the TRH test and urinary MHPG excretion. A significant positive correlation between TSH response to TRH and urinary MHPG was found in the men, though not in the women. These findings suggest that at least for depressed men, central norepinephrine deficiency may be the neurobiological substrate of blunted TSH responses to TRH.


Assuntos
Transtorno Depressivo/sangue , Glicóis/urina , Metoxi-Hidroxifenilglicol/urina , Hormônio Liberador de Tireotropina , Tireotropina/sangue , Adolescente , Adulto , Transtorno Depressivo/urina , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Norepinefrina/metabolismo , Fatores Sexuais
19.
Psychiatry Res ; 4(1): 49-53, 1981 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-6784138

RESUMO

The thyrotropin-releasing hormone (TRH) test and the dexamethasone suppression test (DST) were administered to 50 inpatients with unipolar depression. Of the patients tested, 64% had a blunted thyroid-stimulating hormone (TSH) response to TRH and 50% failed to suppress on the DST. There was no significant association between these two abnormalities by chi-square test. This lack of association suggests that the blunted TSH response to TRH is not an artifact of hypothalamic-pituitary-adrenal hyperactivation. The TRH test and the DST complemented each other as biological markers for active unipolar depression: 30% of the patients were identified by both tests, 34% by the TRH test only, 20% by the DST only, and 16% by neither test. The two tests may be useful in developing a nosology for major unipolar depression that is based on both descriptive and neurobiological information.


Assuntos
Transtorno Depressivo/diagnóstico , Dexametasona , Hormônio Liberador de Tireotropina , Adulto , Feminino , Humanos , Sistema Hipotálamo-Hipofisário/fisiopatologia , Masculino , Testes de Função Adreno-Hipofisária , Testes de Função Tireóidea
20.
Psychiatry Res ; 5(3): 311-6, 1981 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-6798597

RESUMO

The establishment of criteria for a blunted thyroid-stimulating hormone (TSH) response to thyrotropin-releasing hormone (TRH) may prove useful in distinguishing patients with major unipolar depression from patients with nonmajor depressions and controls. To this end, we administered the TRH test to a group of depressed, euthyroid inpatients diagnosed by Research Diagnostic Criteria and 20 normal volunteer controls. The mean maximal TSH response (delta TSH) to infusion of 500 micrograms of TRH of 7.3 +/- SD 4.6 microIU/ml in the 105 patients with major depressive disorder, primary unipolar subtype was significantly lower than that of 13.4 +/- SD 4.4 in the 20 controls and 10.9 +/- SD 4.4 in the 40 patients with nonmajor depressions. The differences were not explainable by differences in baseline thyroid function, age, or sex. When a delta TSH less than or equal to 7.0 microIU/ml was used as a diagnostic test for unipolar depression, the sensitivity of the TRH test was 56%, the specificity 93%, and the predictive value 91%. These results suggest that the TRH test may be useful in confirming the diagnosis of major unipolar depression and hence identifying patients likely to respond to antidepressant medications or electroconvulsive therapy.


Assuntos
Transtorno Depressivo/diagnóstico , Hormônio Liberador de Tireotropina , Adulto , Transtorno Depressivo/sangue , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tireotropina/sangue
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